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Who is really to blame for failing healthcare?

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Picture: Oupa Mokoena/ African News Agency (ANA)/Taken April 11, 2023 – Operation Dudula in partnership with Sisonke People’s Forum, All Truck Drivers Forum Allied of South Africa (ATDFASA) and Voice It In Action (VIIA) protest against the extension of ZEP permits outside the North Gauteng High Court, Pretoria, South Africa.

By Anthony Kaziboni and Sonia Mabunda-Kaziboni

The Johannesburg High Court recently issued an order affirming the right to healthcare of pregnant and lactating women, and children under the age of six to free public healthcare, regardless of their nationality or documentation status.

In South Africa, immigrants have been blamed for failing healthcare by politicians and senior government officials. Unfortunately, some of the populace has come to believe it as it has fueled anti-migrant sentiment and sparked xenophobic incidents at public healthcare facilities – clinics and hospitals.

Section 27 of the 1996 Constitution of the Republic of South Africa states that everyone has a right to health care services. This is further supported by the 2003 National Health Act’s (NHA) Section 4(3) which states certain free healthcare services for people without medical aid. Access is not limited to nationality or immigration status. Therefore, public healthcare services are available to all – citizens and immigrants, regular or not.

Scapegoating immigrants for the national health crisis

The idea that public healthcare facilities are inundated with immigrants is not new. For example, the former Health Minister, Dr Aaron Motsoaledi, once stated, “Our hospitals are full, we can’t control them [immigrants].” Such remarks were recently reverberated by Dr Phophi Ramatuba, the MEC for the Limpopo Province, who stated that foreigners were burdening South Africa’s healthcare system, which was on a “limited budget”. She lambasted a Zimbabwean woman for “killing” her health system.

In support of Dr Ramathuba, political leader and Mayor of Central Karoo District Municipality, Gayton McKenzie publicly stated that as a leader, if an immigrant was on a ventilator and a local needed it as well, he would shut the immigrant’s oxygen for the South African to live.

There are about 4 million immigrants in the country. This constitutes regular or not, comprising about 6.5 percent of the country’s population. Whilst it is true that some hospitals along the country’s borders have a higher number of immigrants visiting them; at this percentage, it is improbable that immigrants are responsible for the national healthcare system’s failings. Furthermore, the country experiences a “healthy migrant” effect – which suggests that in the short run, immigrants are generally healthier than locals.

Worsening vigilantism

The narrow nationalist, fascist vigilante group Operation Dudula, has been targeting public healthcare facilities in the Gauteng metropolitan areas, prohibiting and ejecting immigrant patients, and staff, in some cases, from accessing the facilities for services or work.

In August 2022, Dudula protesters prohibited immigrant patients and employees from accessing the Kalafong Hospital in Tshwane. The Gauteng Department of Health (GDoH) obtained a court interdict against the protestors, which they still ignored. In the same month, a score of Dudula protesters at Johannesburg’s Hillbrow Community Health Centre refused immigrants access to the facility.

Recently, Dudula members chased immigrants from the Jeppe Clinic in Johannesburg. As this vigilante group continues to act with impunity, another one called Combat Movement has taken off in the West Rand’s Zandspruit. Like the former, the fledgling vigilante force refuses immigrants to access the local hospital. This is also the case at the Cosmo City Clinic. Similar incidents have been reported in provinces like Limpopo as well.

People being chased away are reported to be undocumented or irregular pregnant women, children and people with chronic conditions such as diabetes, HIV, high blood pressure and TB. Crude measures like skin colour and language have been used to weed out immigrants. The implications of this will be needless suffering, death and possible infections. In this COVID-19 era, we all will be more vulnerable to the virus.

What do we know about the healthcare crisis in the country?

For immigrants to be responsible for South Africa’s healthcare crisis, evidence must be available. In 2018, then-Health Minister, Dr Motsoaledi, conceded that the DoH did not officially record reliable data on immigrants utilising public healthcare facilities because it was a “very sensitive matter”. He alluded to the existence of “lot of anecdotal data”. This was reiterated by the current Health Minister, Dr Joe Phaahla, during his 2022 Kalafong visit. He stated that immigrants were not to blame for the healthcare problems in the country and that there was no evidence supporting this. He further raised the following debilitating issues: understaffing, an inadequate budget, rampant maladministration and corruption.Personnel shortages in the health sector

In 2022, the South African Medical Association’s (SAMA) chairperson, Dr Mvuyisi Mzukwa, indicated a severe shortage of doctors at public hospitals in the country at a ratio of less than one doctor per 1,000 patients. While local practitioners had difficulties getting placed, the situation was more difficult for immigrant doctors. According to Dr Phaahla, public hospitals had at least 10,800 vacancies for nurses and more than 1,330 for doctors.

To attract highly skilled immigrant healthcare professionals to fill in the gap, the Home Affairs Minister, Dr Motsoaledi, revised the February 2022 critical skills list and added 39 medical professionals. The new list was published in August 2022.

The issue of personnel shortages in the healthcare sector, among other issues, has been raised by labour unions affiliated with the Congress of South African Trade Unions (COSATU) representing healthcare professionals such as the Democratic Nursing Organisation of South Africa (DENOSA), National Education, Health and Allied Workers’ Union (NEHAWU) and the Communications Workers Union (CWU). The Federation and its affiliates submitted a memorandum to the GDoH in 2022. When looking at public healthcare in Gauteng, Dr Mzukwa stated that the “system is in a mess”.

Corruption and maladministration in the health sector

Recently, the DoH has been marred with several severe corruption issues. At a national level, for example, the Digital Vibes Scandal that surfaced in 2021 led to the resignation of the former Health Minister, Dr Zweli Mkhize, over an irregular R150 million tender for Covid-19 personal protective equipment (PPE).

In a bizarre 2022 case in Gauteng, Johannesburg’s Tembisa Hospital purchased 200 pairs of skinny jeans for young girls. The same hospital is alleged to have procured 2,000 hand towels for about R230 each and 100 leather armchairs for R500,000. This surfaced because of a Special Investigating Unit (SIU) for dubious payments, totalling R850 million, made by the hospital. The GDoH ignored more than 200 concerns raised by the late whistle-blower Babita Deokaran before she was murdered.

Last year again, a corrupt DoH official in the Free State was found guilty of theft totalling close to R400,000 and was ordered to pay a fine of R150,000 last year.

The Limpopo Department of Health (LDoH) is also dealing with a PPE scandal amounting to half a billion Rand.

Mounting hefty lawsuits

Another area in which the Health Department loses resources is from mounting lawsuits. According to the Auditor-General, in the 2021-22 financial period, the estimated settlement value of claims against health departments was more than R153 billion. The LDoH is facing negligence claims close to R14-billion.

Medical xenophobia

Xenophobia is a scourge. It’s a form of discrimination, like racism, and should not be condoned. Continued claims of “hordes” or “floods” of immigrants flooding public healthcare facilities promote medical xenophobia. Government must condemn the actions of political leaders and government officials who erroneously blame immigrants for the healthcare crisis. Equally, vigilantes should be rebuked in the strongest terms and decisive action must be taken to deal with perpetrators. The prevention of anyone – citizen or not – from accessing healthcare services undermines social cohesion, tolerance and the social fabric on which this very democracy is founded.

“So, the answer to the question, “Are immigrants responsible for failing healthcare in South Africa?” is, “No!!! There is no evidence that suggests that migrants are responsible for the public healthcare crisis.”

Dr Anthony Kaziboni is head of research, Institute for the Future of Knowledge, University of Johannesburg. He writes in his personal capacity. The views expressed are his own and do not represent the IFK or UJ. Sonia Mabunda-Kaziboni is the International Secretary at the Congress of South African Trade Unions. She writes in her personal capacity. The views expressed are her own and do not represent COSATU.